Biomedical subjects
Publications and source records attributed to D R Levin.
We report a case of metastatic renal cell carcinoma to the bladder. Our patient presented gross hematuria 6 months after treatment of the primary lesion. The possible routes and treatment regimens of metastasis of this site of lesion are discussed and a review of the literature is presented.
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A rare case of abscess of the corpus cavernosum is described. Culture of the abscess yielded beta-hemolytic streptococcus. Ultrasound scan and cavernosography confirmed the physical examination findings of involvement of the corpus cavernosum. The patient was treated successfully by percutaneous ultrasound-guided aspiration drainage and systemic antibiotic therapy.
The authors describe an uncommon case of a huge perinephric abscess with a gas-fluid level occupying the upper left abdomen. A rational sequence of radiological diagnostic methods such as plain film, ultrasound, CT, and combined retrograde urogram with contrast filling of percutaneous drainage led to correct management.
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Extracorporeal shock-wave lithotripsy has altered the therapeutic approach to urinary stone disease. Recently, a method was developed in which shock-wave generation is obtained piezoelectrically. To evaluate the effect of extracorporeal piezoelectric lithotripsy (EPL) on renal function, 20 patients were studied prior to and after EPL of renal calculi. Renal cortical function was evaluated by using a previously described and validated quantitative single photon emission computerized tomography (SPECT) method to measure individual absolute uptake of technetium-99m dimercaptosuccinic acid (Tc-99m-DMSA). Twenty kidneys were treated, and the 19 contralateral kidneys were without stone disease (1 patient had a single kidney). The absolute kidney uptake of Tc-DMSA in the normal kidneys was 21.4% +/- 6.2% before and 22.2% +/- 6.4% after EPL. For the treated kidneys the absolute update was 16.8% +/- 5.3% and 16.8% +/- 4.7% before and after, respectively. There was no statistical significant difference between pre- and post-treatment values. The absolute kidney uptake was significantly lower (p less than 0.01) in the treated than in the normal kidneys. This study indicates that the EPL procedure did not cause any damage to cortical function detectable by the DMSA uptake.
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To date, no standard technique for incisional lumbar hernia repair can be recommended since it depends on the size of the defect in the transversalis fascia. A new technique for this purpose, by using plication of the normal fascia, is described.
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We describe here the first case of an exceptional anomaly consisting of an incomplete quadruplication of the urinary tract in a solitary left kidney. A review of the English literature failed to document such a case.
The effect of distilled water on exfoliated tumor cells from transitional bladder carcinoma was compared to the effect of bacillus Calmette-Guérin (BCG; a nonspecific immunotherapeutic agent) dissolved in either saline or distilled water. The experiment was controlled by comparison to the effect of saline on tumor cells under the same conditions. Distilled water proved as effective as BCG in distilled water (p less than 0.001) and much more destructive than BCG in saline within the 2-hour time limit of the experiment (p less than 0.001).
Since January 1988 we performed 520 extracorporeal lithotripsy procedures for urinary stones with the EDAP LT-01 device. The calculi were localized by ultrasonography and the destructive energy was piezoelectrically generated. Treatment was on an ambulatory basis, without local, regional or general anesthesia. In less than 10% of the patients oral analgetics were given prior to, or during the procedure. Ages ranged from 3-79 years and the mean duration of treatment was 45 minutes. Of the first 210 patients, 148 (70.6%) were free of stones after 3 months, in 28 (13.3%) there was only partial success, and in 34 (16.1%) the treatment failed. It must be emphasized that some have not as yet been followed for as long as 3 months. Hematuria of a few hours duration, and renal colic amenable to oral treatment in 25% of the cases, were the only complications. 4 patients were hospitalized for renal colic, but more because of mental unrest than medical necessity.
A rare case of carcinoma of female urethra from transitional cell origin is reported. The occurrence of primary transitional cell carcinoma in the urethra is being discussed, with review of the literature.
An investigation was carried out into renal injury caused by extracorporeal piezoelectric lithotripsy (EPL) using an EDAP lithotriptor. Four urinary proteins, with a molecular weight range of 160000-14500, immunoglobulin G (IgG), N-acetyl-beta-glucosaminidase (NAG), albumin and lysozyme, were monitored in 27 patients 1 day before and 1, 7, 30, 90 and 180 days after unilateral EPL treatment. All patients had non-obstructive renal stones, previously untreated. Apart from 5 patients with stablised hypertension and 6 with persistent urinary infections due to the infected stones, all patients appeared healthy, as confirmed by clinical, haematological and biochemical investigations. Only albumin levels increased significantly 1 day after treatment; statistically nonsignificant increases and decreases were recorded in the levels of NAG and lysozome respectively. IgG was beyond the limit of detection (less than 0.5 mg%) in all patients. The albumin level returned to normal 7 days after treatment. The EPL-induced increase in albumin was recorded in 88% of patients, compared with increased levels of NAG in 46% and lysozyme in 64%, mainly in those with infected stones. These findings indicated a transient glomerular injury after EPL treatment.
Injuries constitute one of the major disease categories in infancy and childhood. Child abuse is a significant portion of this. A rare case of battered child presenting with acute renal artery occlusion is reviewed.
The unusual occurrence of acute anuria due to external iliac vessel tear is described. Immediate accurate diagnosis helped to prevent unnecessary procedures in a child.
Several immunological in vitro tests were performed on peripheral blood mononuclear cells of patients with adenocarcinoma of the prostate, stages A, B, C, D. The cytotoxicity of effector natural killer cells towards K-562 targets decreased with increasing disease spread, while their percentage was not significantly changed. The proportion of CD4 (helper/inducer) cells tended to fall with tumor advance, but the proportion of CD8 (suppressor/cytotoxic) cells remained almost constant. Secretion of interleukin-2 from peripheral blood mononuclear cells was diminished with disease progression. Pretreatment of a patient's lymphocytes with cimetidine (antagonist of H-2-bearing suppressor T cells) or indomethacin (inhibitor of prostaglandin synthesis) enhanced natural killer activity. Our data point to the existence of aberrant immune functions in early stages of carcinoma of the prostate and to aggravation of these immune abnormalities in advanced disease.